Government Should Slow Down Race To Implement Electronic Health Records

In an unusual move, vendors of electronic health records (EHRs) are asking the government to delay implementation of their products, and focus instead on making sure requirements already set in motion on EHR use are effective. “The pace is too damn high,” says John Glaser, chief executive officer of Health Services at Siemens Healthcare, a major vendor. “People are just cramming this stuff in.”

Health IT companies pushed hard for the 2009 HITECH Act, which disburses taxpayers’ money to hospitals and doctors to help them purchase EHRs, provided they use them according to rules set by Medicare. Thanks to that law, revenues at companies such as Cerner, Epic, and athenahealth have soared.

But the initial euphoria is slightly waning. Government rules which prescribe a one-size fits all approach for everyone, from recording height (even for, say, an orthopedic surgeon), to implementing five clinical decision support “interventions,” have turned out in some cases to be cumbersome. While the need to digitize patient records is imperative, no one knows whether those rules have measurably improved outcomes, so far. “To keep moving ahead with such an aggressive strategy strikes me as foolish,” says Stephanie Reel, vice provost for information technology and chief information officer at Johns Hopkins University. “We don’t know what’s working, and what’s not working.”

Rules are laid out in three stages, ending 2016. Health care providers need to comply, as well as vendors whose technology must meet government specifications. Stage 2 went into effect this past October, and the government has already rushed to release its recommendations for stage 3. After listening to industry comments, it is expected to issue final rules later this year. Vendors are asking that the government delay stage 2 by one year.

The government should listen to the market. “Increasingly [health care] providers will blow you off,” says Glaser. Interoperability, which has never been a priority for vendors or hospitals, is now at the forefront, driven by payments tied to care coordination. Vendors, such as Siemens, want to make sure standards for transmitting patient data between different platforms are adequate by testing them, before they’re set in stone. “We need the time to do it right,” says Glaser.

The biggest casualty might be innovation. For vendors, their electronic health record becomes generic, as they follow government prescriptions to the letter. At Johns Hopkins, the IT department worked daily with a team of 50 doctors to come up with creative ways to improve patient outcome; now IT is too busy meeting government rules. “We’re sacrificing innovation because of requirements to be compliant. The trade off is stark,” says Reel.